Current Standards for Training in Robot-assisted Surgery and Endourology: A Systematic Review.

Different training programs have been developed to improve trainee outcomes in urology. However, evidence on the optimal training methodology is sparse. Our aim was to provide a comprehensive description of the training programs available for urological robotic surgery and endourology, assess their validity, and highlight the fundamental elements of future training pathways.

We systematically reviewed the literature using PubMed/Medline, Embase, and Web of Science databases. The validity of each training model was assessed. The methodological quality of studies on metrics and curricula was graded using the MERSQI scale. The level of evidence (LoE) and level of recommendation for surgical curricula were awarded using the educational Oxford Centre for Evidence-Based Medicine classification.

A total of 75 studies were identified. Many simulators have been developed to aid trainees in mastering skills required for both robotic and endourology procedures, but only four demonstrated predictive validity. For assessment of trainee proficiency, we identified 18 in robotics training and six in endourology training; however, the majority are Likert-type scales. Although proficiency-based progression (PBP) curricula demonstrated superior outcomes to traditional training in preclinical settings, only four of six (67%) in robotics and three of nine (33%) in endourology are PBP-based. Among these, the Fundamentals of Robotic Surgery and the SIMULATE curricula have the highest LoE (level 1b). The lack of a quantitative synthesis is the main limitation of our study.

Training curricula that integrate simulators and PBP methodology have been introduced to standardize trainee outcomes in robotics and endourology. However, evidence regarding their educational impact remains restricted to preclinical studies. Efforts should be made to expand these training programs to different surgical procedures and assess their clinical impact.

Simulation-based training and programs in which progression is based on proficiency represent the new standard of quality for achieving surgical proficiency in urology. Studies have demonstrated the educational impact of these approaches. However, there are still no standardized training pathways for several urology procedures.

European urology. 2024 Apr 20 [Epub ahead of print]

Giuseppe Basile, Andrea Gallioli, Pietro Diana, Anthony Gallagher, Alessandro Larcher, Markus Graefen, Nina Harke, Olivier Traxer, Derya Tilki, Henk Van Der Poel, Esteban Emiliani, Oriol Angerri, Christian Wagner, Francesco Montorsi, Peter Wiklund, Bhaskar Somani, Nicolò Buffi, Alex Mottrie, Evangelos Liatsikos, Alberto Breda

Department of Urology, Fundació Puigvert, Barcelona, Spain; Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy. Electronic address: ., Department of Urology, Fundació Puigvert, Barcelona, Spain; Department of Surgery, Autonomous University of Barcelona, Bellaterra, Spain., Department of Urology, Fundació Puigvert, Barcelona, Spain; Department of Surgery, Autonomous University of Barcelona, Bellaterra, Spain; Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy., Faculty of Medicine, KU Leuven, Leuven, Belgium; Faculty of Health and Life Sciences, Ulster University, Coleraine, UK; ORSI Academy, Melle, Belgium., Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy., Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Department of Urology, Hannover Medical School, Hannover, Germany., Department of Urology, Sorbonne University, Tenon Hospital, AP-HP, Paris, France., Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Koc University Hospital, Istanbul, Turkey., Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands., Department of Urology, Fundació Puigvert, Barcelona, Spain., Prostate Center Northwest, Department of Urology, Pediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany., Icahn School of Medicine, Mount Sinai Health System New York City, NY, USA; Department of Urology, Karolinska Institutet, Stockholm, Sweden., Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK., Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy., ORSI Academy, Melle, Belgium; Department of Urology, OLV Hospital, Aalst, Belgium., Department of Urology, University of Patras, Patras, Greece.